UNIT 12 : ASSESSMENT OF

THE An Elderly Client

Shahzad Bashir

RN, BScN, DCHN, MScN (Std. DUHS)

Instructor

New Life College of Nursing

January 19, 2016

In The Name of God

(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)

Objectives

• By the end of the unit, learners will be able to:

• Describe the common structural changes brought on by

aging in various body systems.

• Recognize the geriatric syndrome.

• Discuss the variations in history taking for an elderly

client.

• Examine elderly client by modifying examination

techniques.

• Describe assessment abnormalities in elderly clients.

• Describe how communication should be varied to

communicate with elderly clients

What is geriatric assessment?

• A geriatric assessment is a comprehensive

evaluation designed to optimize an older person's

ability to enjoy good health, improve their overall

quality of life, reduce the need for hospitalization

and/or institutionalization, and enable them to live

independently for as long as possible.

Normal Changes of Aging

• Physical changes related to “Normal” aging ARE NOT disease

• Changes occur in most body systems to include:

Sensory System

Brain and Central Nervous System

Muscles and Bones

Digestion

Heart/Circulatory System

Respiratory System

1. Describe the following basics of patient

assessment for the geriatric patient:

• Scene size-up

• Initial assessment

• Focused history and physical exam

• Detailed physical exam

• Ongoing assessment

2. Discuss common chief complaints of older

patients.

Cognitive Objectives (1 of 3)

Cognitive Objectives (2 of 3)

3. Describe trauma assessment in older patients for

the following injuries:

• Injuries to the spine

• Head injuries

• Injuries to the pelvis

• Hip fractures

Cognitive Objectives (3 of 3)

4. Describe acute illnesses in older people, including:

• Cardiovascular emergencies

• Dyspnea

• Syncope and altered mental status

• Acute abdomen

• Septicemia and infectious disease

5. Discuss response to older patients in nursing and skilled care facilities.

Psychomotor Objectives

6. Demonstrate the patient assessment skills that should be used to care for an older patient.

• There are no affective objectives for this chapter.

• All objectives in this chapter are noncurriculum objectives.

Geriatric Assessment

• Geriatric assessment has unique challenges.

• The GEMS diamond can be a helpful tool.

• Preexisting conditions may affect findings.

Scene Size-up (1 of 2)

• Be keenly aware of the environment and

why you were called.

• Scene safety should include looking for

unsafe conditions.

• Look for hazards.

– Steep stairs, missing handrails, poor

lighting, other fall hazards

Scene Size-up (2 of 2)

• The general condition of the home will provide

clues.

– Cleanliness, heat, lighting, food

• Look for signs of activities of daily living.

– Personal hygiene, getting dressed, food

preparation

• Scene size-up continues throughout call.

Initial Assessment

• Never assume altered mental status is normal.

• May have to rely on family or caregiver to establish patient’s baseline LOC

• Assess the patient’s chief complaint and ABCs.

Focused History and

Physical Exam (1 of 2)

• History is usually the key in helping to assess a patient’s problem.

• Patience and good communication skills are essential.

• Treat the patient with respect.

• Face the patient and speak in a normal tone.

Focused History

and Physical

Exam (2 of 2)

• Medication history

– Often have multiple medication

– Obtain a list of medications and doses.

– Ask about medications recently started or

stopped.

– Determine if the patient has taken other

medications.

Medication Use

The average geriatric patient takes four or more

medications.

Detailed and Ongoing Exams

• Normal aging may affect physical findings.

– Increased BP, respiratory changes

• Chronic changes can mask acute problems.

• Ongoing assessments will help determine changes.

– Geriatric patients have decreased ability to compensate.

Geriatric syndrome

• The term “geriatric syndrome” is used to capture those clinical conditions in older persons that do

not fit into discrete disease categories.

• Many of the most common conditions cared for by

geriatricians, including delirium, falls, frailty,

dizziness, syncope and urinary incontinence, are

classified as geriatric syndromes.

Common Complaints

• Dyspnea

• Chest pain

• Altered mental

status

• Dizziness or

weakness

• Fever

• Trauma

• Falls

• Generalized pain

• Nausea, vomiting, and

diarrhea

Trauma Assessment (1 of 2)

• Common mechanisms of injury

– Falls

– Motor vehicle trauma

– Pedestrian accidents

– Burns

Trauma Assessment (2 of 2)

• Priorities in rapid trauma are the same.

• Confounding factors:

– Medical conditions or previous injuries

– Dentures or other dental implants

– Decreased ability to compensate

– Changes associated with aging

Injuries to the Spine

• Classified as stable or

unstable

• Osteoporosis is a

contributing factor to

spinal injuries.

• Prompt spinal

immobilization can

reduce further damage

and pain.

– Pad void spaces.

Head Injuries

• Assume a significant

injury in older patients

who have signs and

symptoms of head

injury.

• Suspect brain injury in

patients who take blood

thinners and who suffer

head injury.

• Maintain oxygen

delivery to brain.

Injuries to Pelvis and

Hip Fractures

• Often present as hip or buttock pain

• Pelvic ring disruption can lead to hemorrhage or

internal organ injury.

• Hip fractures:

– Common debilitating injury

– Maintain leg in static position to prevent further

injury.

Hip Fracture

Blanket rolls maintain the leg in a static position so

that further injury does not occur.

Medical Emergencies

• Determining chief complaint is challenging.

– Multiple conditions and complaints

– Ask what bothers them most today.

• Sensation of pain may be diminished.

• Fear of hospitalization

• Conditions may present differently.

Cardiovascular Emergencies

• Classic symptoms are often not present.

• Many have “silent” heart attacks. • Common signs and symptoms

– Difficulty breathing

– Toothache

– Arm pain

– Back pain

Dyspnea

• Related to many causes

– Asthma

– COPD

– Congestive heart failure

– Pneumonia

• Provide oxygen for all patients experiencing

dyspnea.

Syncope

• Can occur for many reasons in geriatric

patients

– Standing up too fast

– Straining to have bowel movement

– Myocardial infarction

– Diabetic shock

Altered Mental Status

• Acute onset is not normal in any patient.

• Most sudden changes are caused by a reversible

condition.

• Evaluate and treat for hypoxia or hypoglycemia if

present.

Acute Abdomen

• Complaints of abdominal pain in older patients

usually indicate a serious event.

• Nervous system response to pain is lessened.

• Consider gastrointestinal problems or abdominal

aortic aneurysm.

Septicemia

• Results from presence of microorganisms or their

toxic products in bloodstream

• Patients may present with:

– Hot, flushed appearance

– Tachycardia and tachypnea

– Hypotension

– Chills, cough

Response to Nursing and

Skilled Care Facilities

• Important information to know from staff:

– What is the patient’s chief complaint today?

– What initial problem caused the patient to be

admitted to the facility?

• Ask the staff about the patient’s overall condition. • Obtain any type of transfer papers.

References.

• Bicklay, L. S. (1999). Bates’ guide to physical

examination and history taking (7th ed). Philadelphia:

J.B. Lippincott.

• Weber, J. & Kelley, J.(2007). Health assessment in

nursing (3rd ed). Williams & Wilkins: Lippincott.